title: Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone.
abstract: BACKGROUND
  With the intention to reduce overshooting immune response, glucocorticoids are frequently administered perioperatively in children undergoing open heart surgery. In a retrospective study we investigated extensively the modulation of the humoral and cellular immune response by methylprednisolone (MP).
  
  
  METHODS
  This study was carried out on blood samples from two groups of children who had undergone surgical correction of atrial or ventricular septal defects, either without (MP⁻, n = 10), or with MP administration (MP+, n = 23, dose median 11 (IQR 10-16) mg kg⁻¹ body weight) before cardiopulmonary bypass (CPB, duration median 42 (IQR 36-65) min). EDTA blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end, 4, 24, and 48 h after surgery, at discharge and at out-patient follow-up (median 8.2 (IQR 3.3-12.2) months after surgery). Complex blood analysis including clinical chemistry and flow cytometry were performed to monitor humoral immune response, differential blood count, lymphocyte subsets, and the degree of activation of various leukocyte subpopulations.
  
  
  RESULTS
  The patients' postoperative courses and follow-up were uneventful. Release of IL-6 and IL8 was reduced and that of the anti-inflammatory cytokine IL-10 upregulated by MP. Significant increase of circulating neutrophils and monocytes as inflammatory reaction to surgery and CPB contact was detected in both groups. However, invasion of monocytes to the periphery was delayed with MP. CD4+ and CD8+ T-lymphocyte counts were lower with MP treatment. B-lymphocyte count increased significantly after surgery in MP+ but remained constant in MP⁻ group.
  
  
  CONCLUSIONS
  MP treatment partially decreased the pro-inflammatory effect of CPB surgery and induced anti-inflammatory effect on the cellular and humoral level.
authors.affiliation: Department of Pediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany.
authors.forename: Jozsef
authors.initials: J
authors.lastname: Bocsi
authors.forename: Marie-Christin
authors.initials: MC
authors.lastname: Hänzka
authors.forename: Pavel
authors.initials: P
authors.lastname: Osmancik
authors.forename: Jörg
authors.initials: J
authors.lastname: Hambsch
authors.forename: Ingo
authors.initials: I
authors.lastname: Dähnert
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sack
authors.forename: Wilfried
authors.initials: W
authors.lastname: Bellinghausen
authors.forename: Peter
authors.initials: P
authors.lastname: Schneider
authors.forename: Jan
authors.initials: J
authors.lastname: Janoušek
authors.forename: Martin
authors.initials: M
authors.lastname: Kostelka
authors.forename: Attila
authors.initials: A
authors.lastname: Tárnok
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000276:immunology / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000276:immunology / Q000601:surgery*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007111:Immunity, Cellular / Q000187:drug effects*; D056724:Immunity, Humoral / Q000187:drug effects*; D018836:Inflammation Mediators / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008775:Methylprednisolone / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011184:Postoperative Period
chemical_list: D000893:Anti-Inflammatory Agents; D018836:Inflammation Mediators; D006854:Hydrocortisone; D008775:Methylprednisolone